"APPLICATION FOR EXPUNGEMENT
OF DISCHARGE RECORD OR OTHER INFORMATION
I, ________________ (Name of Applicant), the undersigned, hereby request the County Recorder of the County of ____________ (Name of County), state of Ohio, to expunge my __________ (Insert Record of Discharge, Separation Program Number or Separation Code from my Record of Discharge and other service-related documents, or Social Security Number from my Record of Discharge and other service-related documents).
Dated this __________ day of __________, _____
_________________________________
(Signature of Applicant)
Sworn to and subscribed before me by ____________ (Name of Applicant) on __________, _____
________________________________________
Notary Public
My commission expires __________, _____"
R.C. § 317.24